Management of Hollowing and Herniation of Lower Eyelid Fat: Blepharoplasty Versus Injection Fillers

A leads to sagging of the eyelid tissues with weakening of the orbital septum thereby causing prominence of the orbital rim and bowing or herniation of the orbital fat producing the classic “double convexity deformity”.1 This defect is more prominent medially know as “tear trough deformity” and laterally known as “hollow eye deformity”. The hollowing effect of the tear trough deformity is the result of 3 factors. The first factor attributing to it is the fixed orbital septum and by the arcus marginal is medially. The second factor is attributed by the intersection of the lateral nasal musculature and orbicularis oculi muscle forming a “triangular gap”. The third factor causing this deformity is by the deficiency of fat and soft tissue in this area, giving the impression of a hollow depressed medial lower eyelid. Aging enhances this deformity due to ptosis of the neighbouring cheek tissue.2 Thus each anatomical entity needs to be addressed individually to provide a customized “best-fit” solution.